Understanding OCD: Symptoms, Causes, & Treatment Options. A Guide to Obsessive-Compulsive Disorder and How CBT Can Help.

Obsessive-Compulsive Disorder (OCD) is often misunderstood, oversimplified, or misrepresented. It is far more than just being "neat" or "particular." For individuals living with OCD, it can be a deeply distressing experience, involving unwanted thoughts and repetitive behaviours that feel impossible to resist.

In this post, we will break down the core symptoms, underlying causes, and the evidence-based treatment options available for OCD... especially the power of Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention (ERP).

What Is OCD?

OCD is a mental health condition that affects approximately 2.3% of the population, or around 1 in 40 adults and 1 in 100 children.

It is made up of two key components:

1. Obsessions

Obsessions are persistent, intrusive, and unwanted thoughts, images, or urges that cause significant anxiety or distress. They can be frightening, confusing, or even go against one’s values or beliefs.

Examples of obsessions include:

• Fear of contamination

• Intrusive thoughts about harming others

• Doubts about safety (e.g., “Did I lock the door?”)

• Unwanted sexual or religious thoughts

• Concerns about your relationship being right

• Extensive existential worries

People often feel ashamed or afraid to share their obsessions, even in therapy, because they find them inappropriate or disturbing.

2. Compulsions

Compulsions are repetitive behaviours or mental rituals performed to reduce the anxiety caused by obsessions or to prevent a feared outcome. They can involve external or internal patterns.

Common compulsions include:

• Excessive washing or cleaning

• Repeated checking

• Arranging objects in a particular way

• Mental reviewing

• Extensive analysing

• Counting, tapping, praying

How OCD Functions: Avoidance and Rituals

To manage the distress of obsessions, many people with OCD develop avoidance strategies (staying away from certain people or objects) or rituals (internal or external actions). These provide temporary relief but reinforce the disorder over time.

CBT therapists often ask: “What do you do to reduce your distress?”; “How often do you do it? For how long?”. Understanding the topography of the ritual, the frequency, duration, and context, helps tailor treatment effectively.

Obsessional Thinking vs. Worry or Rumination

It is important to distinguish obsessions from other mental patterns:

• Obsessions are usually ego-dystonic; they feel alien or unacceptable to the person. They often seem unrealistic, magical, or irrational, and lead to compulsions.

• Worry, on the other hand, is usually ego-syntonic; it feels like a reasonable concern about real-life events (e.g., money, work, family).

• Rumination tends to involve pessimistic or depressive thinking that loops, but usually lacks compulsive rituals to neutralise the thoughts.

Why Do Obsessions Feel So Powerful?

What makes OCD particularly distressing is the meaning people attach to their obsessions.

CBT helps clients explore questions like: “Why is this thought so important to you?”; “What does it mean about you that you had that thought?”; “How likely do you think the feared outcome is?”.

This process, which is called appraisal clarification, uncovers how beliefs formed in early life experiences (e.g., strict parenting, past trauma) may influence OCD thinking today.

For example:

• “My parents told me that sex was bad.”

• “My aunt died in a fire... maybe she was smoking.”

• “My father hit me if my room wasn’t tidy.”

Common Cognitive Themes in OCD

CBT targets several distorted beliefs that maintain OCD:

• Responsibility: “If something bad happens, it’ll be my fault.”

• Perfectionism/Uncertainty: “If it’s not perfect, it’s a failure.”

• Overestimation of Threat: “If I don’t clean perfectly, I’ll catch a disease.”

• Intolerance of Anxiety: “I can’t cope with this feeling.”

• Need for Control: “I must control all my thoughts or something bad will happen.”

These beliefs can be challenged and replaced through structured CBT techniques.

Effective Treatments for OCD

According to clinical guidelines (APA, 2007; NICE, 2014), the first-line treatments for OCD are:

• CBT with Exposure and Response Prevention (ERP)

• Medication (usually SSRIs)

• A combination of both, especially for severe OCD

How CBT Helps

CBT for OCD includes several powerful components:

1. Psychoeducation

Understanding how OCD works helps reduce fear and shame.

2. Exposure and Response Prevention (ERP)

ERP is a gold-standard technique that involves:

• Building a fear hierarchy of situations you avoid

• Gradually exposing yourself to feared triggers without performing the usual rituals

• Staying in the situation long enough for anxiety to decrease (measured by SUDS – Subjective Units of Distress)

• Learning that the feared outcomes are unlikely or tolerable

Therapists guide you through exposures in a safe, encouraging, and nonjudgmental way—never using force or restraint.

3. Cognitive Restructuring

This involves identifying unhelpful beliefs about your thoughts and developing rational alternatives using:

• Evidence testing

• Responsibility analysis

• Continuum techniques (e.g., exploring how common certain thoughts are)

4. Behavioural Experiments

You test your beliefs in real life to see if feared outcomes actually happen, building confidence and challenging distorted thinking.

5. Relapse Prevention

OCD can flare up under stress, so therapy ends with a clear plan for managing future triggers and maintaining progress.

Final Thoughts: There Is Hope

OCD can be overwhelming, confusing, and isolating—but it is also highly treatable.

Research shows that:

• CBT helps improve OCD in up to 75% of cases

• ERP alone can lead to recovery in 60% of people

• OCD doesn’t have to define you or control your life

At Inner Space Clinical Psychology, we specialise in evidence-based, compassionate treatment for OCD. If you or someone you know is struggling, we are here to help guide you toward relief and recovery.

📞 Call us today to schedule a confidential appointment.